The Dershowitz Center Artist in Residency Program
220 36th Street
Brooklyn, NY 11232
APPLICATION FOR 2010-2011 RESIDENCY SEASON
DISCIPLINE: ________________________________________________________________
Literature applicants please enter type of submission: Prose _____ ; Poetry _____; Drama _____
If you apply for more than one discipline, you must submit a separate application form and support materials for each discipline.
NAME:________________________________________________________________
GENDER: Female_____ ; Male_____
COLLABORATION: Yes___ ; No___ Collaborator(s) Name(s):_________________________________________
Collaborator(s) Discipline(s):____________________________________ NOTE: Each collaborator MUST fill out a separate application form. Please write "Collaboration" and Discipline(s) in the Subject Line of the e-mail.
MAILING ADDRESS: __________________________________________________________________________
___________________________________________________________________________
PHONE NUMBERS: Home: (_____)__________________________Work: (_____)_______________________
EMAIL: ________________________________________ URL: _________________________________________
DATE OF BIRTH:____________ PLACE OF BIRTH: (City/State/Country)______________________________
CITIZENSHIP:______________________________
CURRENT EMPLOYMENT: ( in addition to working artist ) __________________________________________
FACEBOOK PAGE: __________________________
FLICKR PAGE: _______________
RELATED SOCIAL MEDIA OR PERSONAL WEB/BLOG PAGE: ________________________________________
List your choice(s) numerically:
3 month residency____
6 month residency____
12 month residency___
ANSWER THE FOLLOWING QUESTIONS:
1. RESIDENCY PROPOSAL: Briefly describe a project on which you might like to work during your residency.
2. WHY ISRAEL AND WHY POLITICAL ART?
3. PROFESSIONAL ACHIEVEMENTS: List and date three professional achievements that you consider to be the most important in your career as a creative artist (i.e., published works, performances, awards, recordings, exhibitions, lectures, etc.)
CHECKLIST: (material to be included in application packet)
PLEASE WRITE YOUR DISCIPLINE IN THE SUBJECT LINE OF YOUR APPLICATION E-MAIL.
Make sure to submit: Application Form, Resume/CV, Work Samples (or URL), Image Description List, Answers to application questions and Statement of Support.
Statement of Support:
Upon signing this application, I understand that the Dershowitz Center Artists in Residency Program is designed as an educational, cultural and artistic community of individuals learning and working together both on their independent projects and on the creation of pro-Israel art.
I support Israel's right to exist in peace and security.
I further agree to abide by the Program’s resident guidelines and policies.
SIGNATURE:______________________________________________________________
DATE:___________
220 36th Street
Brooklyn, NY 11232
APPLICATION FOR 2010-2011 RESIDENCY SEASON
DISCIPLINE: ________________________________________________________________
Literature applicants please enter type of submission: Prose _____ ; Poetry _____; Drama _____
If you apply for more than one discipline, you must submit a separate application form and support materials for each discipline.
NAME:________________________________________________________________
GENDER: Female_____ ; Male_____
COLLABORATION: Yes___ ; No___ Collaborator(s) Name(s):_________________________________________
Collaborator(s) Discipline(s):____________________________________ NOTE: Each collaborator MUST fill out a separate application form. Please write "Collaboration" and Discipline(s) in the Subject Line of the e-mail.
MAILING ADDRESS: __________________________________________________________________________
___________________________________________________________________________
PHONE NUMBERS: Home: (_____)__________________________Work: (_____)_______________________
EMAIL: ________________________________________ URL: _________________________________________
DATE OF BIRTH:____________ PLACE OF BIRTH: (City/State/Country)______________________________
CITIZENSHIP:______________________________
CURRENT EMPLOYMENT: ( in addition to working artist ) __________________________________________
FACEBOOK PAGE: __________________________
FLICKR PAGE: _______________
RELATED SOCIAL MEDIA OR PERSONAL WEB/BLOG PAGE: ________________________________________
List your choice(s) numerically:
3 month residency____
6 month residency____
12 month residency___
ANSWER THE FOLLOWING QUESTIONS:
1. RESIDENCY PROPOSAL: Briefly describe a project on which you might like to work during your residency.
2. WHY ISRAEL AND WHY POLITICAL ART?
3. PROFESSIONAL ACHIEVEMENTS: List and date three professional achievements that you consider to be the most important in your career as a creative artist (i.e., published works, performances, awards, recordings, exhibitions, lectures, etc.)
CHECKLIST: (material to be included in application packet)
PLEASE WRITE YOUR DISCIPLINE IN THE SUBJECT LINE OF YOUR APPLICATION E-MAIL.
Make sure to submit: Application Form, Resume/CV, Work Samples (or URL), Image Description List, Answers to application questions and Statement of Support.
Statement of Support:
Upon signing this application, I understand that the Dershowitz Center Artists in Residency Program is designed as an educational, cultural and artistic community of individuals learning and working together both on their independent projects and on the creation of pro-Israel art.
I support Israel's right to exist in peace and security.
I further agree to abide by the Program’s resident guidelines and policies.
SIGNATURE:______________________________________________________________
DATE:___________
